While enthusiasm for bariatric surgery continues to grow, concerns regarding variations in quality are pervasive. Unfortunately, the value of quality profiling efforts is limited by problems with the existing measures. Further, despite a growing interest in value-based purchasing, there is little evidence linking quality and costs for bariatric surgery. Based on a statewide clinical registry, the Michigan Bariatric Surgery Collaborative (MBSC), linked to payment data from Blue Cross and Blue Shield of Michigan (BCBS), this proposal has 2 specific aims: Specific Aim 1: To develop a composite quality measure for bariatric surgery. Using detailed clinical data from the MBSC, we will develop an empirically weighted composite measure that overcomes many of the limitations of existing quality indicators. We will validate the composite measures by determining the extent to which it explains hospital level variation and forecasts subsequent performance. Specific Aim 2: To better understand the relationship between quality and costs for bariatric surgery. Using claims data from BCBS of Michigan, we will study the payment history of all patients undergoing bariatric surgery. Based on the composite measure derived in Aim 1, we will then assess relationships between hospital quality and costs. Better measures of quality for bariatric surgery will help ensure the success of the growing number of accreditation and quality improvement efforts of payers, policymakers, and providers. PUBLIC HEALTH RELEVANCE: Better measures of quality for bariatric surgery will help ensure the success of the growing number of accreditation and quality improvement efforts of payers, policymakers, and providers.